The Case of Grace
Addressing racial disparities in treatment of ADHD
David Anderson, PhD, and Stephanie Lee, PsyD
Like so many in the mental health community, we at the Child Mind Institute have been deeply troubled by the story of a Black teenager incarcerated for not doing her court-mandated schoolwork. The teenager, whom the media is calling Grace, has ADHD, and like many students with learning disorders she lost much-needed school supports during the pandemic. She has struggled with remote learning, and for that a judge put her in juvenile detention.
Here, we present a frank, thoughtful conversation between two expert clinicians who discuss learning disorders, race and the damaging effects of the school-to-prison pipeline.
Dr. David Anderson, PhD: The story we’re today discussing today is about a 15-year-old the media is calling Grace. We know that she and her mother had some conflicts years ago, and that Grace has been diagnosed with ADHD and has an individualized education plan at school that helps provide support for academics.
When the coronavirus crisis hit, Grace already had some contact with a social worker who was providing support, and she was also attending school online in Michigan. After her school moved to a distance-learning format, Grace’s mother reported to the social worker that Grace was not attending class as much as she needed to be and that she was having difficulty finishing her assignments. Grace’s mother had also apparently emailed her teacher, and Grace’s teacher said that Grace’s participation was not actually that different from a lot of the other kids’ engagement with online learning at that time.
But Grace was on probation at that time. And at her hearing with a judge in Michigan, her teacher was unable to appear, and the caseworker reported to the judge that Grace was unable to attend school exactly as was required.
The judge decided to detain Grace in a juvenile detention facility where she has been since early in the coronavirus crisis, effectively for violating the circumstances of her probation by not doing her online schoolwork. Those are the details as we know them. And of course, because Grace is a minor as well, there are details of the case that are kept confidential in order to protect her identity.
Dr. Stephanie Lee, PsyD: There are a number of aspects about Grace’s case that are particularly troubling. The first thing that jumps out to me is the fact that Grace was struggling so much with remote learning, and we know that Grace is not alone. We know that children and adolescents with ADHD and specific learning disabilities have been struggling this whole time with remote learning.
Her teachers were reporting that actually what Grace was doing was not so different from her peers, and yet the punishment was so severe for her.
Dr. Anderson: What’s really not being paid enough attention to at the moment, especially in this case but really across the country, is that many students who have ADHD or learning challenges really need the in-person support they get in school. But as the coronavirus crisis hit, we saw supports evaporate for kids who have learning challenges, especially during online learning.
Dr. Lee: We’ve also noticed that because kids are learning from home, they have to be much more independent in their work and organization than they might have been before. And at the same time, their parents might have less time and energy than before to check in and help students stay on top of things.
Instead of giving more resources and more support, this is about taking away that learning support. What we know about suspensions, and about any type of punishment that is designed to keep kids out of the classroom, is that those punishments are not just ineffective but really cause kids to be spiral and unravel even further.
Dr. Anderson: When it comes to thinking about why this might happen, there’s a lot to be said about racial disparities and treatment access in communities of color.
Dr. Lee: We also know that ADHD is often overlooked in females and often misdiagnosed. And that is, again, very troubling, because that may be another reason that those resources probably weren’t available to Grace.
Dr. Anderson: That’s an important point about what systemic biases were involved in this case. We already know that just on a basic level, ADHD is often not seen as a real thing. It’s seen as, “They need to try harder,” when in fact it’s a brain-based mental health disorder that really requires significant support. And as you said, ADHD symptoms are often overlooked in females because it’s not thought of as being as consistent with their gender role.
There’s also the racial factor in this case. In communities of color across the country, there’s often a lack of access to psychologists and social workers who provide support for things like ADHD. There’s a much higher frequency of police contact in incidences of family conflict or in the instances where mental health and learning disorders affect families.
It’s also much more likely for kids of color to be referred for merely medication treatment. This is not to say that medication treatment can’t be effective for ADHD; it’s just that you oftentimes need additional support developing organizational skills and coping strategies. Medication alone is not a solution, and we know that in communities of color those types of support services are lacking. So Grace’s situation is not unique for communities of color, and unfortunately it’s part of what contributes to a school-to-prison pipeline in lieu of access to mental health services.
Dr. Lee: It’s also important to note that children of color tend to get much harsher punishments. In school, children of color who have inattentive behaviors are often categorized as problematic. They’re often sent to the principal’s office, sent out of the classroom, and they are more likely to be suspended. They’re more likely to have a consequence to their behavior that is not therapeutic and is not designed to support them or to provide them the environmental resources that they need.
I think what’s most troubling about Grace’s situation is that there are so many kids like her — she’s just the one whose story we know. This kind of punishment is probably going on much more frequently than has been brought to the media’s attention. This is just one example of an adolescent not getting what they need when it actually is very clear what she would benefit from.
Dr. Anderson: The key point is that she is in a juvenile detention facility likely for having a mental health diagnosis that could be treated outside of that facility. What’s perhaps somewhat unique is that Grace’s diagnosis was actually known going into this. A lot of times, kids who end up in juvenile detention facilities have a diagnosis that’s figured out after they’re detained, and that could have been a source of prevention.
Dr. Lee: In particular, we know that females of color are more likely to be overlooked for diagnosis because the ADHD symptoms or the learning disability symptoms might be coming across in slightly different ways, and adults and school staff aren’t looking for them in the same way. And then even when adults do see those symptoms, they might categorize them as disruptive behavior.
Dr. Anderson: For kids of color, these symptoms are often seen as willfully defiant, or the kids are seen as not caring, when the reality is that these kids have a condition that requires extra support and empathy. So Grace, like many kids of color across the country, is more likely to end up in a courtroom. White children in this country are much less likely as a result of circumstances like these to end up in that courtroom.
What’s particularly unjust is that Grace’s case has been re-reviewed and even seeing the circumstances, the fact that outpatient support could help with this and the fact that her mother and her teacher and her caseworker are advocating for this change, the judge’s decision has not changed. Grace remains detained at a juvenile detention facility for something minor that could be helped outside the facility.
Dr. Lee: Absolutely, and not just something minor, but honestly something that almost all of the other teens in her position were struggling with. There’s not one family that we’ve worked with over the COVID crisis that has said, “I’ve got it. No problem. My child with ADHD is signing on to all of their remote learning independently with no issues.” Even children without learning disabilities, even children without ADHD, were struggling with some of that remote learning. So it really does feel that she’s being punished in a way that her peers are in very similar situations have not been.
Dr. Anderson: You and I both see the circumstances of Grace’s case reflected in so many families we work with. We know many families who’ve had significant conflict between a single parent and a child where some of their fights have gotten very much out of hand. The difference is that those families may not have had police contact as a result of those conflicts — they haven’t had a social worker assigned as a result. And at the same time, they may not have had the same level of scrutiny on the kids’ attendance or performance in school as a function of probation. The reality is that we’ve seen lots of kids have difficulties like Grace has had, and it’s just tragic that she’s not being allowed to work out these difficulties in the context of the support she truly needs.
To learn more about Grace, read the full story in ProPublica.